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Describe the arguments for integrating
medical content in the context of student
learning.
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Cite examples of at least three means of
integrating basic science and clinical content.
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Demonstrate an appreciation of the logistical
and human barriers to achieving integration.
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Describe how an integrated preclinical
curriculum might look.
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Why integrate?
The dreaded question:
“What have you had on this before?”
What is different about an integrated
curriculum?
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Does it have to be absolute?
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What does it require?
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Integrated Curriculum Rationale
University of Virginia School of Medicine
Why a System-based Curriculum?
In response to several national trends in medical education
and healthcare as well as the research, recommendations, and
subsequent discussions of the Curriculum 2020, Education
Task Force, and Working Group on Clinical Skills Education,
the School of Medicine is creating a system-based curriculum
that is more content-integrated, learner-centered, and
clinical performance-oriented. Specific reasons for this
change include: Scientific (i.e. evidence-based) teaching and
learning decisions create learner-centered classrooms and
more significant learning experiences which, in turn, lead to
better academic outcomes.
Cognitive psychology has demonstrated that teaching,
practicing, and assessing knowledge and skills in the context
in which they will be used leads to better recall and
application. The learning of medicine then should occur
within a clinical context or framework to energize students
and improve retention of knowledge, skills, and attitudes.
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The USMLE Gateway Format will result in a more integrative and
competency based licensure examination program. The USMLE
redesign will lead to a substantial increase in and emphasis on
fundamental medical science in clinical contexts as well as
clinical decision making based "on the doctor's ability to access
relevant information, evaluate its quality, and apply it to solving
clinical problems" (see Comprehensive Review of
USMLE and USMLE Moves to Next Step in Design Review).
The Curriculum 2020, Education Task Force, and Working Group
on Clinical Skills have uniformly called for a content-integrated
and learner-centered curriculum that develops the competencies
required of a contemporary physcian.
The LCME expects an integrated, outcome-based medical
education curricula comprised of well-defined learning
objectives and active learning activities and appropriate
assessments of students' clinical competencies. Medical school
applicants have similar expectations.
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The shift to an integrated, systems-based
medical curriculum represents a national trend
and is certainly not unique to the University of
Virginia School of Medicine. Scores of medical
schools have already or are currently creating
system-based system curricula and/or
incorporating active learning into each phase of
medical education. Visit the Johns Hopkins
University, Stanford University, University of
Pittsburgh, UNC-Chapel Hill, University of
Pennsylvania, Vanderbilt University, University of
Vermont, and Yale University websites to read
about a few of them.
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Full integration vs. “choreography”
Informed choreography
Engaging the clinical faculty
Someone takes charge
Some are easier than others
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There is more than one way to integrate
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Integrate around:
Disease states
Organ systems
Life stages
Environments
AOA Competencies
PBL presentations
Comlex
Is anything wrong with a hybrid approach?
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Documentation is critical
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Do the maps in detail
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Utilize technology (CurrMit)
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Do not underestimate admin. support needs
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Ask the students if it is making sense to
them… just because you have to label it as a
subject does not mean you are de-integrating
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Integrated Curriculum
The UCF M.D. program curriculum fully integrates basic and clinical sciences
across all four years. The first two years of the curriculum are structured into
modules, with the first year focusing on a fundamental understanding of how the
various basic science disciplines relate to the normal human body. The second
year takes an organ system-based approach and applies the basic knowledge of
the first year to the study of clinical disease, pathological processes, and
treatment. In concert with these aspects of medicine, the curriculum also covers
psychosocial issues, cultural differences, communication skills, and physical
diagnosis skills as they relate to the different topics in medicine.
The third and fourth years of the curriculum are devoted to clinical experience
through clerkships, selectives, and electives. The clinical curriculum provides
practical patient experiences complemented by basic science lectures,
simulations, journal clubs, and conferences throughout the six core clerkships.
Integrated throughout all four years of the M.D. program, Longitudinal Curricular
Themes (LCT’s) will emphasize critical aspects of medicine and medical care that
are not addressed in the basic core curriculum. The LCT’s include Ethics and
Humanities, Gender-Based Medicine, Medical Informatics, Medical Nutrition,
Geriatrics and Principles of Palliative Care, Culture, Health and Society, and Patient
Safety. Each of these themes will be highlighted when appropriate in the core
curriculum and reinforced through a variety of interactive experiences.
Overall, the four year medical curriculum at UCF is designed to fully integrate
basic science and clinical medicine, provide students with appreciation of cultural
diversity and the need for sensitivity in treating patients, foster professionalism in
all interactions, and ignite a passion for life-long learning.
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INTEGRATED CASE EXERCISE
Students will be provided a case history for each patient
along with questions to facilitate a subsequent discussion
within the small group emphasizing:
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the epidemiology and genetics of the patient’s disorder
the patient’s clinical features that are typical or atypical Of
the disorder
the features of the disorder the patient has not manifest
the immunologic mechanisms contributing to the patient’s
disorder
cellular, biochemical and/or immunologic targets for
treating the disorder
current areas of investigation relevant to the disorder
Group reports summarizing the case discussions will be
submitted, followed by a review session convened with the
entire class to review the patient presentations and
discussion questions. The review session will also
emphasize summer student research opportunities in the
Division of Clinical Immunology and Rheumatology
applicable to the respective disorders.